Optimal Reconstruction of Sagittal Alignment According to Global Alignment And Proportion Score Can Reduce Adjacent Segment Degeneration After Lumbar Fusion

Wang, Muyi; Xu, Liang; Chen, Xi; Zhou, Qingshuang; Du, Changzhi; Yang, Bo Kyu; Zhu, Zezhang; Wang, Bin; Qiu, Yong; Sun, Xu

doi:10.1097/brs.0000000000003761

Cited by 18 publications

(13 citation statements)

References 26 publications

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“…Several studies report conflicting results on the GAP score's ability to predict MCs [15][16][17][18][19][20][21][22][23][24]. To our best knowledge, very few studies have specifically investigated the discriminatory power and threshold of the GAP score for those [15,16,24].…”

Section: Discussionmentioning

confidence: 99%

“…The strength of this study is the relatively long follow-up time. To our best knowledge, there are very few long-term studies on the evaluation of the GAP score with more than five years of follow-up, as most studies meet a minimum follow-up period of two years [15,16,[18][19][20][21][22][23]. In addition, we had an established clinical care team made up of highly experienced spine surgeons and nurses, and patient reachability for controls in the relatively stable catchment area was high.…”

Section: Discussionmentioning

confidence: 99%

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Mechanical complications and reoperations after adult spinal deformity surgery: a clinical analysis with the GAP score

et al. 2023

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Purpose Adult spinal deformity (ASD) surgery is prone to postoperative complications, leading to high reoperation rates. The global alignment and proportion (GAP) score is a novel method to predict mechanical complications (MC) based on the optimal parameters related to individual pelvic incidence. The aim of this study was to determine the cut-off point and the predictive value of the GAP score for those MCs that require reoperation. A secondary aim was to investigate the cumulative incidence of MCs requiring reoperation during a long follow-up period. Methods In total, 144 ASD patients were operated at our institution due to marked symptomatic spinal deformity between 2008 and 2020. The cut-off point and the predictive value of the GAP score for the MCs that required reoperation and the cumulative incidence of reoperated MCs after index surgery were determined. Results A total of 142 patients were included in the analysis. The risk for having an MC that required reoperation was significantly lower when the postoperative GAP score was < 5 (HR = 3.55, 95% CI: 1.40–9.02). The discriminative power of the GAP score to predict MCs that require reoperation was good with an AUC of 0.70 (95% CI: 0.58–0.81). The cumulative incidence of reoperated MCs was 18%. Conclusion The GAP score was associated with the risk for MCs that require reoperation. The best predictive value for surgically treated MC was with the GAP score $$\ge$$ ≥ 5. The cumulative incidence of the reoperated MCs was 18%.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mechanical complications and reoperations after adult spinal deformity surgery: a clinical analysis with the GAP score

et al. 2023

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“…Moreover, long-segment fusion will further increase the occurrence of ASD compared with either short-segment fusion or other non-fusion approaches ( 20 ). The long-segment fusion might affect the global sagittal alignment of the lumbar spine and increase the ROM of adjacent segments compared with the short-segment fusion ( 21 ). This observation is consistent with the findings in our study; we also found that the occurrence of ASD is significantly increased in the long-segment fusion group compared with that in the short-segment fusion group ( Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

Comprehensive comparison of three techniques for the treatment of adjacent segment degeneration after lumbar fusion

He²,

Zhang³

et al. 2023

Front. Surg.

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PurposeAdjacent segment degeneration (ASD) following lumbar fusion is technically challenging for spine surgeons. Posterolateral open fusion surgery with pedicle screw fixation is an effective way to treat symptomatic ASD with favorable clinical outcomes; however, it is associated with an increased morbidity rate. Therefore, minimally invasive spine surgery is advocated. This study was designed to compare clinical outcomes among patients with symptomatic ASD who underwent percutaneous transforaminal endoscopic discectomy (PTED) with the transforaminal approach, posterior lumbar interbody fusion (PLIF) with cortical bone trajectory screw fixation (CBT-PLIF), and PLIF with traditional trajectory screw fixation (TT-PLIF).MethodsA retrospective study was conductedon 46 patients (26 men and 20 women; average age 60.8 ± 6.78 years) with symptomatic ASD. The patients were treated with three approaches. The operation time, incision length, time to return to work, complications, and the like were compared among three groups. Intervertebral disc (IVD) space height, angular motion, and vertebral slippage were obtained to assess spine biomechanical stability following surgery. The visual analog scale (VAS) score and Oswestry disability index were evaluated at preoperation and 1-week, 3-month, and the latest follow-ups. Clinical global outcomes were also estimated using modified MacNab criteria.ResultsThe operation time, incision length, intraoperative blood loss, and time to return to work for the PTED group were significantly decreased compared with those for the other two groups (P < 0.05). The radiological indicators in the CBT-PLIF group and TT-PLIF group had better biomechanical stability compared with those in the PTED groups at the latest follow-up (P < 0.05). The back pain VAS score in the CBT-PLIF group was significantly decreased compared with those in the other two groups at the latest follow-up (P < 0.05). The good-to-excellent rate was 82.35% in the PTED group, 88.89% in the CBT-PLIF group, and 85.00% in the TT-PLIF group. No serious complications were encountered. Two patients experienced dysesthesia in the PTED group; screw malposition was found in one patient in the CBT-PLIF group. One case with a dural matter tear was observed in the TT-PLIF group.ConclusionAll three approaches can treat patients with symptomatic ASD efficiently and safely. Functional recovery was more accelerated in the PTED group compared with the other approaches in the short term; CBT-PLIF and TT-PLIF can provide superior biomechanical stability to the lumbosacral spine following decompression compared with PTED; however, compared with TT-PLIF, CBT-PLIF can significantly reduce back pain caused by iatrogenic muscle injury and improve functional recovery. Therefore, superior clinical outcomes were achieved in the CBT-PLIF group compared with the PTED and TT-PLIF groups in the long term.

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“…7 8 9 ASD may compromise the operative results and even might require reoperation. Risk factors for ASD after lumbar fusion include high body mass index (BMI), 10 longer fusions, 11 intraoperative damage to the facet joint of adjacent segment, 12 destruction of posterior stabilizing structures, presence of ASD preoperatively, 2 10 decompressive surgery on adjacent segments, 1 unsatisfied postoperative global alignment and proportion score, 13 among others.…”

Section: Discussionmentioning

confidence: 99%

Does Simultaneous Fusion of Preexisting Spinal Canal Stenosis Adjacent to Lumbar Degenerative Spondylolisthesis Achieve a Better Clinical Outcome? A Retrospective Study with More than 5-year Follow-Up

Wang

Zhang

Wang³

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Background In this study, we investigate the effect of simultaneous fusion of preexisting adjacent spinal canal stenosis on the outcome of patients with lumbar spondylolisthesis. Methods Patients with lumbar spondylolisthesis who underwent transforaminal lumbar interbody fusion (TLIF) from August 2013 to March 2016 were included. The inclusion criteria were the following: single-level spondylolisthesis (L4 or L5) and mild to moderate spinal stenosis at cranial adjacent segment of the spondylolisthesis segment before operation. According to whether the adjacent stenotic segment was included in the scope of surgery, the patients were divided into two groups: group A, only the spondylolisthesis was treated with single-level TLIF, and the adjacent stenosis was not treated with any surgery; In group B, TLIF were performed in the spondylolisthesis segment and the adjacent stenotic level; no spinal stenosis was found in other levels. The patients were followed up for more than 5 years. The general information before operation, visual analog scale (VAS) scores of low back pain and leg pain, and Oswestry disability index (ODI) scores before operation and at the last follow-up were recorded. Results A total of 23 patients were included in group A, and 24 patients were included in group B. There was no significant difference between the two groups in gender distribution, age, course of disease, level of slippage, length of stay, degree of spondylolisthesis, stenotic grade of adjacent segment, and intervertebral disk degeneration grade (p> 0.05). The blood loss during surgery in group B was significantly higher than that in group A (p< 0.05). The operation time of group B was longer than that of group A, but the difference was not statistically significant (p = 0.245). There was no significant difference in preoperative VAS and ODI scores between the two groups. At the last follow-up, the VAS scores of low back pain in the two groups were almost the same. However, the VAS scores of leg pain and ODI scores in group B were slightly higher than those in group A at the last follow-up, but the difference was not statistically significant (p> 0.05). If relatives and friends have the similar disease, all the patients of group A and 87.5% of patients in group B would recommend that type of surgery. The satisfaction of group A (100%) was higher than that of group B (79.17%), but the difference was not statistically significant (p = 0.068). Conclusions For single-level lumbar spondylolisthesis with mild to moderate spinal stenosis in adjacent segment before operation, decompression and fusion on the level of spondylolisthesis only is a safe, less invasive, and economical surgical option, with good long-term clinical efficacy and high satisfaction rates.

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Optimal Reconstruction of Sagittal Alignment According to Global Alignment And Proportion Score Can Reduce Adjacent Segment Degeneration After Lumbar Fusion

Cited by 18 publications

References 26 publications

Mechanical complications and reoperations after adult spinal deformity surgery: a clinical analysis with the GAP score

Mechanical complications and reoperations after adult spinal deformity surgery: a clinical analysis with the GAP score

Comprehensive comparison of three techniques for the treatment of adjacent segment degeneration after lumbar fusion

Does Simultaneous Fusion of Preexisting Spinal Canal Stenosis Adjacent to Lumbar Degenerative Spondylolisthesis Achieve a Better Clinical Outcome? A Retrospective Study with More than 5-year Follow-Up

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